Provider Demographics
NPI:1063518801
Name:KUTSOWSKY, JANE (OD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:KUTSOWSKY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S MAIN ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2477
Mailing Address - Country:US
Mailing Address - Phone:732-252-6555
Mailing Address - Fax:732-312-5249
Practice Address - Street 1:130 S MAIN ST
Practice Address - Street 2:UNIT 4
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2477
Practice Address - Country:US
Practice Address - Phone:732-252-6555
Practice Address - Fax:732-312-5249
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 006545152W00000X
NJ27OA00584200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02331271Medicaid
NY08204GOtherGHI MEDICARE
NY08204GOtherGHI MEDICARE
NY02331271Medicaid
NYC240D1Medicare PIN